2006 年至 2014 年安大略省第一民族人群中的丙型肝炎病毒感染：基于人群的回顾性队列分析。

Hepatitis C virus infection in First Nations populations in Ontario from 2006 to 2014: a population-based retrospective cohort analysis.

机构信息

Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont.

出版信息

CMAJ Open. 2021 Sep 28;9(3):E886-E896. doi: 10.9778/cmajo.20200164. Print 2021 Jul-Sep.

DOI:10.9778/cmajo.20200164

PMID:34584007

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8486470/

Abstract

BACKGROUND

Hepatitis C virus (HCV) infection causes substantial morbidity and mortality in Canada and is of concern among First Nations communities. In partnership with the Ontario First Nations HIV/AIDS Education Circle, we described trends in HCV testing and epidemiologic features among Status First Nations people in Ontario.

METHODS

In this retrospective study, we used health administrative databases for 2006-2014 in Ontario with 3 cohorts of Status First Nations people: those tested for HCV for the first time, those who tested positive for HCV antibodies or RNA, and those with no HCV laboratory or testing records. We examined cohort characteristics, and the annual prevalence and incidence of testing and diagnosis of HCV infection. Outcomes were stratified by region, sex and residence within or outside of First Nations communities.

RESULTS

During the study period, 2423 Status First Nations people were diagnosed with HCV infection, 20 481 received their first test, and 135 185 had no test record. The point prevalence of ever having been tested increased from 6.3 (95% confidence interval [CI] 6.2-6.5) per 100 people in 2006 to 16.2 (95% CI 16.0-16.4) per 100 people in 2014. The point prevalence of diagnosed HCV infection increased from 0.9 (95% CI 0.9-1.0) to 2.0 (95% CI 1.9-2.0) per 100 people. The incidence of first test and of diagnosis increased from 12.1 (95% CI 11.5-12.6) to 21.3 (95% CI 20.5-22.1) per 1000 person-years and from 1.3 (95% CI 1.1-1.5) to 2.3 (95% CI 2.1-2.6) per 1000 person-years, respectively. Testing, diagnosis and prevalence of HCV infection were consistently higher among people living outside of versus within First Nations communities, but larger increases over time were observed among those living within First Nations communities.

INTERPRETATION

Testing and diagnosis of HCV infection increased from 2006 to 2014 among Status First Nations people in Ontario. Our findings indicate the need for population-level efforts to eliminate hepatitis C in First Nations communities.

摘要

背景

丙型肝炎病毒（HCV）感染在加拿大造成了大量的发病率和死亡率，并且在第一民族社区中受到关注。我们与安大略省第一民族艾滋病毒/艾滋病教育圈合作，描述了安大略省在册第一民族人群中 HCV 检测的趋势和流行病学特征。

方法

在这项回顾性研究中，我们使用了安大略省 2006 年至 2014 年的健康管理数据库，其中有三个在册第一民族人群队列：首次接受 HCV 检测的人群、HCV 抗体或 RNA 检测呈阳性的人群以及无 HCV 实验室或检测记录的人群。我们检查了队列特征，以及 HCV 感染检测和诊断的年度患病率和发病率。结果按区域、性别以及在第一民族社区内外的居住地进行分层。

结果

在研究期间，2423 名在册第一民族人被诊断患有 HCV 感染，20481 人接受了首次检测，135185 人没有检测记录。曾经接受过检测的人数的点患病率从 2006 年的每 100 人 6.3（95%置信区间 [CI] 6.2-6.5）增加到 2014 年的每 100 人 16.2（95% CI 16.0-16.4）。诊断 HCV 感染的人数的点患病率从 0.9（95% CI 0.9-1.0）增加到 2.0（95% CI 1.9-2.0）每 100 人。首次检测和诊断的发病率从每 1000 人年 12.1（95% CI 11.5-12.6）增加到每 1000 人年 21.3（95% CI 20.5-22.1），从每 1000 人年 1.3（95% CI 1.1-1.5）增加到每 1000 人年 2.3（95% CI 2.1-2.6）。检测、诊断和 HCV 感染的患病率在居住在第一民族社区内外的人群中始终较高，但在居住在第一民族社区内的人群中，随着时间的推移，增长率更大。